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Wednesday, August 31, 2016

ObamaCare
Not as Bad as It Sounds

It’s not as bad as it
sounds.

Mark
Twain, commenting on Richard Wagner’s music

ObamaCare may not be as bad as critics make it sound.
It has insured 20 million previously uninsured Americans by subsidizing them in
the health exchanges or moving them into Medicaid.

But critics say it sounds bad because taxpayers must carry
the load of the subsidies and Medicaid.Not only that, but unsubsidized consumers face an average of 23%
increases in premiums in 2017 (sometimes 50% to 62% spikes in some states) and
deductibles sometimes exceeding $800 before they can even see the doctor.And those same consumers have in increasingly
limited choice of doctors, hospitals, and health plans.

Thoughtful taxpayers, looking ahead, are asking, “How
are we and our children going to pay for
a $20 trillion nation debt and $100 million in promised Medicare, Medicaid,
Social Security and other entitlements after President Obama leaves office?”

While contemplating this and other questions,consumers might want to commentaries like
the following.

Obama Sabotages Obamacare

By Grace-Marie TurnerForbes | August 29, 2016

As health
insurers head for the exits, Americans who have been whipsawed by ObamaCare may
get whacked again this fall: First, they were thrown off private plans
that were declared illegal, then they were forced into the ObamaCare exchanges,
and now they could face the prospect of being shut out of coverage through
their exchanges entirely for 2017.

In Arizona’s Pinal County, for example,
no insurers are offering coverage through the exchange. While decisions won’t
be final until next month, people in other counties could face a similar fate.

Elsewhere, millions of Americans will have a “choice” of just one carrier,
especially in rural areas. It’s likely that Alabama, Alaska, and Oklahoma will
have only one health insurer selling individual coverage on their exchanges
next year. South Carolina and most of North Carolina could join that list as
well.

Nearly one-third of the nation’s
counties are likely to have just one insurer offering health plans
on the exchanges next year: Last year, 50 Texas counties had only one insurer
offering individual plans, according to data from the Texas Department of
Insurance. Next year, Texans in 57 counties will have
only one choice. Exchange customers in many Florida counties will be
offered only the Blues plans.

United Healthcare, Humana, and some Blues plans were the first start the
exodus from the ObamaCare exchanges. But when Aetna CEO Mark Bertolini announced in
mid-August that his company will dramatically reduce its individual public
exchange participation to just four states, it created an earthquake.

Aetna had been all in for ObamaCare, investing billions to offer coverage
through the ACA exchanges. But after losing $430 million in this market since
January 2014, Bertolini had to answer to his shareholders.

Insurers are pulling out largely because the exchange risk pools are getting
worse, not better as the White House had promised. They are losing money
and see little or no prospect for the bleeding to stop.

The sicker risk pools mean coverage will be much more expensive next
year with the carriers that remain.

Some consumers face even higher increases: BlueCross BlueShield of Tennessee
received a 62% premium increase after documenting losses of $500 million on its
exchange business over the last three years. Texas Blue Cross has filed for a 58% increase for its
603,000 exchange policyholders after reporting $1.2 billion in losses on these
plans over two years. In Pennsylvania, High Mark Blue Cross is asking for
an average 41% increase.

Tennessee’s insurance commissioner says the exchange in
his state is “very near collapse.” Tennessee either had to approve the
requested increases or see companies drop out.

ACA supporters say exchange enrollees will largely be shielded from these
increases because their coverage is subsidized. But someone is paying,
and it is the beleaguered taxpayer. Further, half of those in the
potential individual health insurance market aren’t eligible for subsidies and
would have to pay these exploding costs in full.

The higher premiums will drive even more healthy people away from the exchanges
and leave costs even higher for the remaining (sicker) population. In the
ObamaCare plan with the lowest premium—the Bronze plans—the average individual
deductible for 2016 is $5,765. For a family plan,
the deductible is $11,601. A growing number of healthy people figure they might
as well be uninsured as pay high premiums for policies with such expensive
deductibles.

The Obama administration has only itself to blame for the ObamaCare
failures—first for jamming this bill through Congress despite warnings that the
structure of the bill was an economic disaster, and then for exacerbating the
breakdown through its regulatory dictates. The ACA was sold on the
pretense that we could have a private, competitive market for health insurance,
but the law and subsequent regulations put the industry in a straightjacket,
with rules at every turn that undermined the industry’s ability to offer attractive,
competitive products.

The president over-promised on what his law would be able to do—saying it would
dramatically cut health insurance costs for middle-income Americans while
assuring them they could keep their coverage and their doctors. His administration
tried to patch over the serious political problems with the law—and cover for
the broken promises—with whack-a-mole regulatory fixes that have only worsened
them.

Now, exchange coverage is threatened because the costs of expensive,
sick enrollees are not being offset by a greater number of healthy members.

Clearly, the president’s own policies are driving people away from ObamaCare.

The Congressional Budget Office expected ACA
enrollment to reach 21 million this year, but the actual number likely will be only half that. That
is one of the main reasons for the huge premium increases the remaining
companies are forced to request.

The law required insurers to misprice risk—charging older, sicker people less
and younger, healthier people more. Young adults have balked at paying up to 75% more than their
actual cost so a 64-year-old can pay 13% less. No amount of regulatory
tinkering can fix this unstable economic model.

The flawed and even illegal subsidies to insurers through reinsurance payments
to insurers are not enough to make up for their losses, as documented in
research by health policy experts Doug Badger, Brian Blase, Ed Haislmaier, and
Seth Chandler.

Some critics say that insurers are happy with being the only player left in a
state or county. But that means they are the magnet for all of the
high-risk patients with no ability to spread the loss, leading to even larger
losses and higher prospective premiums.

The next president will inherit this mess. Those who supported
this disastrous and unworkable government intervention into the marketplace now
say we need more government to fix the problems government has created. They
believe the solution is to pour more taxpayer dollars into subsidies for
individuals and insurers and to expand government even further through a
"public option." More big government and more subsidies to insurers will not solve the
underlying and fundamental problems with the law.

The reality is that if Republicans hold even one house of Congress, they will
be very reluctant to pass any "fixes" to the program and will not
create a public option, especially after the cascade of co-op failures built
on the public-option model.

Instead, Republicans will look to advance elements of their own Better Way plan and
will work to garner bipartisan support.There are areas of potential
compromise: Reconfiguring ACA tax credits into advanceable tax incentives
paid in monthly installments to health-care consumers themselves. The
credits could be used to pay for health coverage that consumers want rather
than policies they are forced to purchase by the federal government. Insurance
would be regulated by states to give consumers more coverage options with more
sensible regulations.

Instead of the highly-unpopular individual mandate in ObamaCare, Republicans
would provide strong incentives for people to stay insured through “continuous
coverage protection.” States could gain more control over Medicaid to
give them an incentive to spend federal and state dollars on this program in
ways that provide better access to care than the current balkanized program
does.

We need to think more broadly about solutions, making sure that people getting
coverage now are protected, that those not buying or obtaining coverage have
greater incentives to participate, and that the program is financially
sustainable.

Grace-Marie Turner is president of the Galen Institute, a non-profit
research organization focusing on free-market ideas for health reform. www.galen.org

Its life will be short if Republicans win election and repeal
ObamaCare, the opportunity for implementation will be fleeting if health
exchange market assumptions continue to collapse,its experiments with doctor payments and
regulation will be treacherous as physician shortages mount and doctors refuse
to accept more Medicare and Medicaid patients,and if its judgments of how to fix it if the new Congress does not pass
a Public Option provision.

It’s really not as complicated
as it is sometimes portrayed.Insurersneed to make a profit to
stay in business.To make a profit,insurers need the right mix of the healthy
and the sick and the young and the old. That mix is not forthcoming.Major insurers – United, Aetna, and Humana –
are pulling out of markets.Government-run Consumer Operated and Oriented Plans are going bankrupt.For consumers,choices are disappearing,prices are rising, markets are too small to
predict profitable premiums, the rules are too complicated to comprehend,too few people , half of what predicted, are
joining the exchanges,and the
government’s economic assumptions, that consumers would welcome government intervention
with subsidies for the have-nots and higher-taxes for the haves.

There’s another factor as
well.A country-wide health care
transformation with disruption and lower revenues for most health care
providers is not progressing as planned. Many clinicians and hospitals are not cooperating or are resisting its provisions.As
Richard Bohmer of the Nuffield Trust in London observes,a health care transformation is hard work
(New England Journal of Medicine, August 25, 2016).Such a transformationrequiresredesign of the entire system, the redesign teams are typically led by
clinicians “Clinician-led teams take control of patient-facing organizations
subsystems and reform clinical protocolas and operations and make modifications,
review performance data and make modifications.. and actively create the local
system needed to provide the best possible care.”This sounds good in theory, but in
practice,many clinicians distrust
government,revolt against protocols,
guidelines, and algorithms robbing them of their autonomy and income ,and do not see quality and efficienciespromised by reformists.“The most substantial hurdle,” to health
care reform, “ is a change in mindset.”That change has not yet occurred among most of America’sindependent physicians in private practice.

Sunday, August 28, 2016

California
-A Wonderful Place to Live

California’s
a wonderful place to live – if you happen to be an orange.

Fred
Allen (1894-1956), American Comedian

California is a wonderful place to live – if you happen to
like warm weather, are a Democratic politician,aspire to be an actor or television star,crave to be part of the California high-tech Silicon
Valley Community,if you are of
Hispanic heritage – 30% of California speak Spanish as their primary language)or
if you’re an observer of the good of ObamaCare – the number of uninsured there
has dropped by 40% - and the bad – premiums are scheduled to go up an average
of 13% in 2017.

Although the California economy is the 6th
largest in the world if you think of it as a nation,life is not so wonderful for small
business,who are exiting the state in
record numbers to adjoining states and places like Texas and Florida.The reasons for their departure are
self-evident – the nation’s highest personal income tax at 13%,the most regulated business sector, a high cost of living and property, fear
of wild fires and shortage of water during its record drought, and unusually
heavy health care expenses, which are causing big insurers to pull out of the
state.

Still California for most people remains a great place to live.It has over 39 million residents , a $2.4 trillion economy,world class universities like Stanford and
the University of California,and the
U.S.’s most widely known and admired private health care plan in Kaiser Health
Care. And it’s a huge climatically diverse state, the 3rd largest
geographically after Texas and Alaska.You can always find something in California to like and to escape to, it’s a great place for oranges,other fruits, and nuts,, and for servers, transistors,
and apps.You have a choice: love it, move elsewhere inside it, or
leave it.

Saturday, August 27, 2016

The
Internet Monster

What a monster have we created with the Internet?Today newsindicates that hackers have targeted mobile cell phones to attack banks
and their customers.The Internet is reshaping
our society, causing us to look down at our smart phones and tablets, not into
each others’ eyes, robbing us of our privacy,and stealing our identity and our
money. Now we are even wandering the streets,in search of any monster, Pokemon-Go.

In the short span of 20 years, the Internet Monster has
replaced the Cookie Monster.If you’ll
recall, the Cookie Monster was created to appeal to children on Sesame Street.
Its mantra was: “Me want cookies! Me eat cookies! Me eat anything and
everything!”Its appetite was insatiable.It ate in broad daylight. It ate a night.It ate behind closed doors. It ate your breakfast, lunch, and dinner.It ate 24 hours a day.It was always raiding your personal cookie
jar.It ate things you were not even
aware.

The Internet Monster puts the Cookie Monster to shame.It obesses the entire population.Its appetite for your total attentionis insatiable.It is everywhere – on your personal computer,
your tablet, your smart phone, on corporate
and government website, amazon, facebook,Instagram,Internet servers ,
even in the “Cloud,” anywhere and every where you look for information, a loan,
for something to buy, borrow, or steal, anything that forwards, delivers, and
stores information.

Everybody is interconnected,which is not the same as being interoperatible .The Internet is like a uncoordinated electronic
octopus with countless tentacles, unconnected to any central brain.It has common mobile operating systems- like Apple Inc’s iOS and Alphabet Inc’s
Android – but even these systems, like the federal government’s systems,are vulnerable to hackers.

The Internet Monster’s message system is email which has
largelyreplacedsnail mail,in the process nearly bringing down the U.S. Postal System.Almost anyone can hack email, likeconvicted sex offender Julian Assuage of
Wikileaks.

You can never really hide what you text on emails.You can try to hide it, destroy it,bleachbit it.Email is the Hacker’s Paradise, that golden treasury
and trough of embarrassing information.

The Internet Monster has transformed politics.You can never hide what you have
taxted.Iti is always somewhere in
storage.It is the fodder and grist of
controversie.It is an integral part of
vast left-wing and right-wing conspiracies. It may yet undo Hillary Clinton’s
campaign – through some September timebomb or Donald Trump’s campaign – through
a maladroit tweet,

It has destroyed or displaced multiple industries - brick and mortar stores, the publishing industries - books and newspapers, clerks and secretaries and middle manager, even entire towns. like Rochester, New York, and its film industry.

It has changed personal relationships.You can no longer engage in ordinary open conservations and llo into some’s eyes or read their body
language.You must text. You must carry your mobile device wherever you
go or whatever you’re doing,like
walking, eating, or driving.You must constantly
focus on the screen, look down rather than up,connect electronically,to make
sure you do not miss anything, no matter how trivial,as long as your are paying allegiance to the
Internet Monster,which dominates your
every waking moment or piling up email messages while you sleep.

Thursday, August 25, 2016

The following
article is from Kaiser Health News?It raises this fundamental question -does MACRA(The Medicare Access and CHIP Reauthorization Act) – which
discourage fee-for-service and encourages ACOs (Accountable Care Organizations and APMs (Alternative Payment Models ) spell
the end of small private practices which depend on Medicare patients for their
existence?

Doctors Raise Concerns For Small Practices In Medicare’s
New Payment System

Dr. Lee
Gross is worried. He has practiced family medicine in North Port, Florida, near
Sarasota, for 14 years. But he and two partners are the last small, independent
practice in the town of 62,000. Everyone else has moved away, joined larger
groups, or become salaried employees of hospitals or health companies

“We’re
struggling to survive,” Gross, 47, said. “Our kind of practice is dying in this
country, and medicine itself is changing so rapidly that doctors everywhere
seem to be burning out.”

Indeed,
in their professional journals, at conferences, on social media and health care
blogs, and in comments to federal regulators, the nation’s doctors are
expressing growing anger and frustration.

The
focal point of their angst is a 2015 federal law that changes the way Medicare
pays doctors.

“This is
a big change, we know,” said Tim Gronniger, deputy chief of staff at the
Centers for Medicare & Medicaid Services. But, he added, “the current way
we pay doctors incentivizes them in bad ways — to waste resources, for
example.”

The law
has bipartisan support and does not come with the political tension of the ACA.
Still, the Obamacare battles have shown that broadly reshaping health care is
no easy task.

That
would total between $875 billion to $1.1 trillion of the $3.5 trillion expected
to be spent on health care in the U.S. in 2016.

The law
sets up two payment tracks. All doctors must choose one, except for those who
see too few Medicare patients or whose income from Medicare is too low.)

On one
track, doctors whose performance and quality of care exceeds benchmarks get
bonuses up to 4 percent of their total Medicare reimbursements. Those will
start in 2019, based on evaluations of care delivered in 2017, and will rise a
maximum of 9 percent by 2022. By the same token, physicians who score poorly on
quality benchmarks — which include requirements for the use of electronic
health records — face penalties at the same levels.

The
amount the government spends on the bonuses — estimated at $833 million for
2019 — must be balanced by the penalties, keeping the program “budget neutral.”
However, Congress also authorized an extra $500 million a year bonus pool
through 2024 for doctors judged “exceptional.”

On the
other path, doctors choose to join larger practices or organizations — called
“alternative payment models” — that would be held accountable for the
quality of care delivered by all the doctors in the organization.

Congress’
intent, experts say, was to push doctors to join such larger organizations,
which generally are considered better equipped to manage and coordinate care,
improve quality and lower costs than are solo or small groups of doctors.

Doctors
get a 5 percent annual bonus between 2019 and 2024 if they join an alternative
payment organization, along with any bonuses or penalties the
organization chooses to mete out. Starting in 2026, doctors in such
organizations will continue to get a small annual payment adjustment from
Medicare that’s larger than doctors who don’t choose the alternative path —
0.75 percent versus 0.25 percent.

Physicians’
concern is that the new payment system — laid out in a 962-page proposed regulation in April — will put doctors
in solo or small practices at high risk of incurring payment penalties and will
push thousands into larger practices and alternative payment organizations.

“The
ways it’s structured now, the large practices will do well and the small
practices will do badly,” said Paul Ginsburg, director of the Center for Health
Policy at the Brookings Institution.

During a
public comment period, the American Medical Association and dozens of other
physician trade organizations and every state medical association said the
system needs to be simplified and must “accommodate the needs of physicians in
rural, solo, or small practices in order to enhance their opportunities for
success and avoid unintended consequences.”

One of
those unintended consequences, the AMA says, is that penalized doctors would
limit the number of Medicare patients they see, or drop Medicare.

“I have
no idea what I’m going to do yet,” says Dr. Jean Antonucci, a primary care
physician who has a solo practice in Farmington, Maine. Half her patients are
covered by Medicare. “If I’m going to lose money, I’ll have to see what my
options are. I don’t want to limit how many Medicare patients I see."

“I don’t
want to spend the bulk of my time doing paperwork or collecting data on my
patients,” said Jean Antonucci. (Courtesy of Jean Antonucci)

Antonucci
and Gross say they want to preserve their small practices. “I don’t want to
spend the bulk of my time doing paperwork or collecting data on my patients,”
said Antonucci. “That’s what the doctors in my community who are employed [in
larger groups] seem to spend most of their time doing.”

Some
experts agree that the burden to report quality-of-care to the government is
significant.\

“We
don’t yet have a good system to measure the performance of individual
physicians,” says Robert Berenson, a physician and fellow at the Urban
Institute and former director of Medicare payment policy for the federal
government. “And yet we are going to peg billions of dollars in payment to such
measurement. It’s a little crazy.”

A study published in March in the journal Health Affairs
calculated the scope of that data collection now. It found physicians and their
staffs spend $40,000 per doctor per year — $15.4 billion nationwide —
collecting and reporting information about their care to Medicare, private
insurers and others.

Gronniger
says CMS has, in the proposed rule, scaled back the number of measures doctors
must report. “We are eager to work through the issues doctors’ groups have
raised,” Gronniger said.

Even so,
the AMA and other physician groups are pushing CMS to delay the start for collecting
quality-of-care information from next January until at least July.
Medicare administrators have pledged to issue final regulations by Nov. 1.

“This is
all very complex,” said AMA President Andrew Gurman. “A lot of doctors are very
frustrated … but we are committed to trying to make the new law work.

Wednesday, August 24, 2016

ObamaCare
Endgame: Achieve Savings by Redistributing Income from Specialists to Primary Care Physicians

MACRA (Medicare Access and CHIP
Reauthorization Act of 2015) which shifts traditional Medicare patients into
risk-based reimbursementby giving
doctors incentives to join with hospitals to formAccountable Care Organizations to share “savings” with hospitals and to
join organizations that employ primary care organizationsin order to achieve savings by reaching measurable quality goals by reducing the
specialty care referrals.According to Robert Kocher, MD, and Anuraag Chigurapati, MS, at policy institutes at the University of California, Stanford, and Harvard, the MACRA endgame is designed to redistribute income to primary care physicians from specialists ("The Coming Battle over Shared Savings - Primary Care versus Specialists," New England Journal of Medicine, July 14, 2016,) In a sample chart in their article, the authors project MACRA could reduce incomes for diagnostic radiologists by $35,000 and cardiologists by $25,000, thereby narrowing the average incomes of $284,000 of specialists versus $195,000 for primary care physicians. Will this MACRA scenario work in the real world?

Specialty care is by far the most expensive cost Medicare
has to bear.In the minds of CMS officials and progressive
elistists,at least 30% ofMedicare costs are unnecessary and can be
traced to physician and hospital greed, which depend on specialty referrals as
their major sources of revenue.By
curtailing specialty referrals,theoretically
one could save money by reducing hospital days,ER visits, lengths of stay in
skilled nursing facilities, and intensity of diagnostic testing and procedures performed by specialties.

To accomplish the goals envisioned by CMS,one simply needs tomeasure the outcomes of Medicare
populationsby measuring“population health”,by shifting risks to primary care
physicians,and by preaching the gospels
of evidence-based medicine and “value” health , both of which are loosely defined
as outcomes and quality control per doctors expended.

The basic belief system here rests on a fundamental thesis
of management,“In God we trust, all
others use data.”If you impose enough regulationsand impose enough documentation rules,somehow, somewhere, somehow, government “savings” will be achieved.Unfortunately,
Government bureaucracies have no history
of achieving savings, and trust in government has reached an all time low.

ACRA requires a leap of faith in government experts to do
the job of reform, on the ability o0f government experts to analyze complex
systems,on sophisticated technocratic
analysis, and government rule-writing on the most equitable solution to socialinequities.I am profoundly skeptical about MACRA.It’s hard to understand, rests on non-commonsensical assumptions, and
its bloated bureaucratic rules will raise costs.Pitting primary care doctors against
specialists will be psychological offensive t many doctors,and it won’t raise quality since many consumers regard
specialty essential in many instances.

Tuesday, August 23, 2016

The elitist media cannot contain itself.Although the mainstream media portrays itself as dispassionate ,fair-minded,and compassionate, it cannot help itself when it comes to labeling
Donald Trump as a moral degenerate, a lowly demagogue,an outright bigot,a flaming racist, and an egocentric narcissist.

Cokie Roberts

Cokie Roberts, who has been called the mother of NPR, has gone as far as to say his supporters are immoral.“Trump is one of the least qualified candidates ever to
make a serious run for the presidency." Roberts wrote late last month in a
syndicated column with her husband, the
journalist Steven Roberts. "If he is nominated by a major party — let
alone elected — the reputation of the United States would suffer a devastating
blow around the world."

Robertsalso is an
commentator for ABC news, which along with CBS, NBC,MSNBC,the Washington Post, and the New York Timesis one of the pillars of the mainstream
media.

New York Times

-- In his left column front-page piece,the headline reads “Trump’s Empire: A Maze of
Debts and Opaque Ties; U.S. Holdings Examined;At Least $65 Millionis Owed by
Republican Nominee’s Firms.”The gall
of the guy, “The success of his empire depends on his ability to get credit, to
get loans extended to his business entities,and we simply don’t know a lot about his financial dealings, here or
around the world.” The obvious implication of the articles is that there’s
something rotten in the Trump Tower of Debt.

Sunday Review Section

--In the Sunday Review section of the August 23 New York Times, the paper threw all
pretense of objectivity,either by its
writer, reporters, columnists, or editorial board. Its editorial bore these
headlines, “Can America Recover from Donald Trump” and“Mr. Trump and the Damage Done” and concludes,“Trump supporters have now been promise a
nation where non-natives, and their children are locked outside the borders
forever…The challenge to responsible leaders o any political party will be to
separate the economic discontents form the bigotry and paranoia that the key to
the Trump phenomenon.

--The front page of the Sunday Reviewhas this headline, “Donald Trump Takes Aim,”
and asserts “his message resonates with voters who feel guns are all they have.”

--A column“Low and Lower” contains 18 quotes from
various sources on how low Trump has sunk (example” Trump’s groundless
assertionshis a new low last week, as
the mass shooting in Orlando, when he repeatedly suggested that President Obama
secretly supports the Islamic state.

--And Maureen Dowd, in her
column “Open Letter from Mr. T rump,”commenting on Trump’s speech saying he was sorry if this remarks had
offended anybody,lists 15 reasons
Trumps should feel sorry about his sorry performance.Each reason oozes with sarcasm and contempt
over why Trump should feel sorry.“Most
of all, “ she ends, quoting Trump, “I’m sorry that I’m not really sorry.”

Friday, August 19, 2016

Trump’sApology and Humbleness Speech

I listened closely last night to Donald Trump’sscripted speech last night.

Trump apologized for past blunt or harsh statements,appealed directly to Afro-Americans for their
support,said he was a law and order
candidate, and gave a bleak assessment of what the future would look like under
a President Hillary Clinton.That
same night Paul Manafort, his campaign manager, resigned. Today Trump visited Baton Rouge to show he cared more about flood-ravaged people than President Obama who was playing golf at Martha's Vineyard among the Democratic swells.

Will this new scripted Trump change the trajectory of the
currentpolitical campaign,which at the moment,is decidedly and decisively in favor of
Hillary Clinton if you believe the Real Clear Politics average of polls, which should
Clinton ahead in 7 or the 9states Trump
needs to win?

Can Trump convert this into a “change election,” based on a
discontent with the economy,ISIS “radical
Islam” threats,bias against police, unhappiness with a dysfunctional health law,
and a populist revolt against the establishment on both sides of the political aisle.

Can Trump,like Harry
Truman before him, come frombehind as a
political underdog to win in a late
season political surge?

Can Trump neutralize a powerful mainstream and social media
to win the hearts and minds of enough women, college graduates, and
millenialsto squeak out a political victory?

Is Hillary Clinton like a modern-day ship like the Queen
Mary, impossible to turn around on a dime?

Will some technological revolution,like jet plans making the Queen Mary obsolete
or further email scandals, change the political chemistry

Can she just sit on her lead and her Democratic assets, which includes 98% of the black vote,70% of the Hispanic vote, and at least 60% of
the women’s and youth vote.

Will some catastrophic event,like a 9/11 attack or a shopping mall massacre,or large scale terrorist happenings in
Europe, change the political equation?Will more email revelationsof Hillary perjuries , change peoples’
minds?

I am enjoying the
State Department’s and Obama administration’s explanation of why the $400
milliongiven in exchange for the
release of 4 American Iranian held prisoners was not a ransom.

Instead the $400 million in cold hard cash which arrived by
plane while the prisoners waited for their release was a “highly leveraged contingency”
mechanism springing them loose from their imprisonment.The $400 million was an installment on $1.7 billion
deal that had been negotiated years
before in a court at the Hague in 1981,

The $400 million was
not “ransom,” but a move calculated to
save American taxpayers interest on an internationally agreed up deal.The fact that the plans landed on the same
day was strictly “ coincidental ,”and
had nothing to do with the prisoners’ release, unless you factor in the current
State Department admissionabout the
releasebeing “highly leveraged” to
spring the hostages.

It may not make any difference who is right here.The point is thatthe money and the prisoner release were
closely related and are viewed by political opponents,the Iranians,and the world at large as a ransom, which is defined at the release of a
prisoner or kidnapped person for a price paid or demanded.In other words,if it looks like a ransom,works like a ransom, smells like a ransom,
and releases prisoners like a ransom,it’s
a ransom and can used a precedent for future ransoms.

Thursday, August 18, 2016

Who Are
You Going to Believe:Insurance Actuaries
of ObamaCare Visionaries?

Who are
you going to believe, me or your lying eyes?

Groucho
Marx (1895-1977)

Following the lead of other major health insurers, Aetna has
withdrawn from 536 of 778 ObamaCare health exchange markets.This abrupt withdrawal reminds me of a
Groucho Marx story.

When his wife caught him in bed with another woman, Groucho
denied any wrong doing.He asked his
wife,”Who are going to believe me or your lying eyes?

Betrayal?

In my blog title, I use the word “betrayal” because
President Obama promised consumers they could keep their plans, doctors, hospitals,while keeping their premiums low.Instead, of course, consumers have
found few of these promises apply to them.The old phrase “finders keepers” apparently does not apply to ObamaCare.

In
the case of health insurance,health
actuaries are the “lying eyes,” and “me” is the government who is telling them
what they are experiencing isn’t reality. Actuaries are financial experts hire to
calculate the “actual “ reality-based
risks.The government policy people
are promissory visionaries of what they think might happen.

Who to Believe?

Who are you going to believe independent actuariescalculating risk who are predicting insurers
must increase premiums by an average of 18% to 23% across multiple markets or
government officials, who are saying don’t believe your eyes, things will get
better.

Doug Badger and Marilyn Travenenar,
former CMS and government officials,now
working on the anti-Obama side of the ledger say CMS is “cooking the books” to
hide heavy losses and to present a falsely-positive view of the future( “Adjusting ObamaCare Reality,” National Review Online, August 16. 2016). Travenner notes,“Insurers,unlike government spin doctors, understandthat, while one can adjust the numbers,one cannot adjust reality.For insurers to participate in ObamaCare – as
well as consumers and taxpayers, who bear the brunt of the law’s costs and
dislocations, the reality isn’t good.”

Don’t worry say ObamaCare
advocates, we’re from the government and you can trust us. Every comprehensive government
program has hiccups (Jeff Spross, “ObamaCare Is Not Doomed “,August 16,The Week, and “Editorial
Board, “ObamaCare Will Survive,” New York
Times, August 18, 2016).

Government and ObamaCare can always
print money, incur debt, and stay in business by increasing subsidies,having taxpayers bail them out, passing a
Public Option, and offering Medicare toeverybody over 55,Never mind that
enrollment in exchanges have been flat, at 11 million half of what was
predicted,that there is too much “churn”
as enrollment drop out after receiving care, and that exchange polices are not attractive
to health people.

Could it be that highly
compensatedconservative actuaries are lousy at math?Could it be that ObamaCare is simply designed
by pie—in-the-sky theorists who have no concept of risk and profit and who
dedicated to the proposition that failures will lead to universal care if we
only wait long enough to come to our senses?

Monday, August 15, 2016

In a forthcoming
August 22 issue ofThe Weekly
Standard,Jeffrey Anderson has an
article entitled “All the Issues Favor Trump.”

Anderson lays out these
issues.

·Immigration

“Start with immigration—the defining issue of Trump's unlikely
triumph in the GOP race. According to the U.S. Census Bureau, the percentage of
the U.S. population that is foreign-born has already surpassed the percentage
during the great waves of immigration in 1880 or 1920. That percentage, 13.6
percent, has almost tripled since 1970 (from 4.7 percent) and is on course to
exceed 15 percent within a decade. A Gallup poll last year found that 60
percent of Americans are dissatisfied with current immigration levels, with
more than five times as many wanting to see those levels decreased (39 percent)
as increased (7 percent).

·ObamaCare

“That leads us to Obama's centerpiece
legislation, the second big issue favoring Trump. Charles Gaba, an Obamacare
supporter, estimates that the average premium increase that insurers are
requesting for Obamacare plans in 2017 is a whopping 23 percent. Many insurers
are bailing out. The slow-motion death spiral is proceeding. Real Clear Politics lists 206 polls
taken on Obamacare so far during Obama's second term—3 found it to be popular,
202 found it to be unpopular, 1 has found a tie.”

Trump says, ‘We will repeal and
replace disastrous Obamacare,"’ and he has been briefed on the House GOP
alternative and likes it. Clinton says she will’defend and expand the
Affordable Care Act.’ In a clear step toward a true government monopoly, she
says that she would add a "public option"—a government-run plan—to
Obamacare. The Democrats couldn't even pass the "public option" when
they had 60 votes in the Senate and a 75-seat margin in the House. That's how
politically toxic it was—and likely remains.”

·The Economy

‘ObamaCare has
thrown a wet blanket over the economy, but it is hardly the sole example of a
heavy-handed program of regulation and redistribution that has stymied economic
growth under Obama. According to the Commerce Department's Bureau of Economic
Analysis, after adjusting for inflation, average yearly GDP growth under Obama
has been an anemic 1.5 percent—last among the 12 postwar presidents and less
than half of President Jimmy Carter's tally (3.3 percent). Even Obama's best
year of growth (2.6 percent, in 2015) was below average across the past 70
years. Median household income, moreover, has fared worse under Obama than the
GDP has.

In response, Trump
talks of trade deals that put America first, making American businesses more
internationally competitive by cutting the corporate tax rate to 15 percent
(down from 35 percent today), reducing personal taxes, introducing a temporary
moratorium on federal regulations, and lifting restrictions on all sources of
American energy—in short, keeping governments, both others' and our own, from
undermining the efforts of American workers.”

·Law and Order and Terrorism

“Moreover, immigration, Obamacare, and the economy are hardly the only issues
favoring Trump. At a time when violent crime has begun to rise again, Trump is
focused on restoring law and order, while Clinton is focused on increasing
leniency in criminal sentencing. At a time when new terrorist attacks are
occurring every few days or weeks, Trump isn't skittish about saying
"Islamic terrorism" and can't be held responsible for ISIS's
ascendancy, while Clinton is and can. At a time when we are approaching $20
trillion in national debt—nearly double what the tally was when Obama took
office—Clinton is calling for "free" college. At a time when the vast
majority of Americans oppose providing taxpayer funding for abortion, Clinton
is calling for killing off the Hyde Amendment, the longstanding protection
against such practices that for decades enjoyed bipartisan support. (What's
more, then-senator Clinton repeatedly voted against what is now the federal ban
on partial-birth abortions.)”

The Problem

So what is Trump’s
problem?His problem is his pugnacious
personality, his lack of likability, his imprecise blunt language, his stabs at
sarcasm, his incendiary off-the-cuff remarks.The presidential campaign is not a food fight.It is not name-calling. It is not a neighborhood brawl. It is not even a business deal. It is a contest to find a credible national
leader with an even temperamentand
disposition.

The Health Reform Maze

Buy the Book

Book Description: In this first book in a series of four, Richard L. Reece, MD. provides a unique view of the roll out, and run up, of the Affordable Care Act. Reece shows in this book the progress and facets of ObamaCare's marketers and messengers, as the day approached for the launch of health insurance exchanges - the single most public and problematic portion of the new law. This is a must read for anyone who wants to chronicle this attempt to organize more than one-sixth of the U.S. economy by adding layers of federal government control and regulations.

Reece has been writing about U.S. health care for more than 45 years. His knowledge and experience, added to his keen intellect and gift of subtle humor, make this book a valuable part of anyone's collection.